Provider Demographics
NPI:1427343623
Name:NGUYEN, THI THANH (DO)
Entity type:Individual
Prefix:
First Name:THI
Middle Name:THANH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 HIGHWAY 365
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-7716
Mailing Address - Country:US
Mailing Address - Phone:409-344-4557
Mailing Address - Fax:
Practice Address - Street 1:3620 HIGHWAY 365
Practice Address - Street 2:SUITE 400
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-7716
Practice Address - Country:US
Practice Address - Phone:409-344-4557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP7823207Q00000X
TXP74823207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine